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workbook Questions Flashcards

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1
Q 
What are:
Level 1a
Level 1b
Level 2
General Observations on the ward?
A

1a: nurse in arms reach
1b: nurse can see
2: checked & documents every 15mins
General obs: checked & documented every 60mins

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2
Q

WhatarethechaptersincludedintheICD­10?

A

1-17: Diseases & other morbid conditions

18: symptoms/signs/abnormal clinical & lab findings not elsewhere classified
19: injuries, poisioning & certain other consequences of external causes
20: external causes of morbidity & mortality
21: factors influencing health status & contact with health services

(F01-99: Mental, Behavioural & Neurodevelopmental disorders)

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3
Q

Describetheinteractionsbetweenmentalandphysicalhealth

A

Psychological response to physical illness:
Uncertainty about future, search for meaning, anger, sense of failure, stigma, isolation

Psychiatric illness as a consequence of psychological response to physical illness:
Adjustment disorder, anxiety states, affective disorders, body image probs, sexual probs, eating disorders, substance misuse, PTSD

Patients presenting with mediacally unexplained symptoms may be due to:
Undiagnosed physical illness, somatisation (bodily complaints, assumed to arise from psyk disturbance, but contributed to organic illness), psychiatric illness, malingering (deliberate exacerbation of symptoms for obvious gain), fictitious disorder (fabrication of symptoms without obvious motive), dissociation/conversion disorder

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4
Q

Whatisdysthymia

A

Persistent, mild depression

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5
Q

Whymightdepressionbemorecommoninwomen?

A

Bio: women experience specific forms of depression-related illness, including premenstrual dysphoric disorder, postpartum depression and postmenopausal depression and anxiety, that are associated with changes in ovarian hormones

Psycho: women more often present with internalizing symptoms and men present with externalizing symptoms

Social: differences in socioeconomic factors: including abuse, education and income

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6
Q

Whatsocialfactorsmakepeoplevulnerabletodepression?

A 
Poor childhood experiences
Traumatic life events
Poor relationships
Substance misuse
Financial issues
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7
Q

Whataretheindicationsforelectro­convulsivetherapy(ECT)?

A

Severe depressive illness (concerns over health/safety)
Uncontrolled mania
Catatonia

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8
Q

WhataretheadvantagesanddisadvantagesofSSRIsas

comparedtotricyclicantidepressants?

A

Relatively safe in overdose (TCA: cardiotoxicity, anticholinergic SEs)
More selective & inhibits re-uptake of serotonin (TCAs: mainly NA)

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9
Q

Whatis“thoughtbroadcast”?

A

Delusion that thoughts are being transmitted to everyone around

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10
Q

WhatarethecoresymptomsofschizophreniaaccordingtotheICD classification?

A

Fundamental & characteristic distortions of thinking & perception, and affects that are inappropriate or blunted

Clear consciousness & intellectual capacity usually maintained

Most important psychopathological phenomena:
Thought echo, insertion, withdrawal, broadcasting
Delusional perception, delusions of control
Influence or passivity
Hallucinatory voices commenting or discussing patient in 3rd person
Thought disorders
Negative symptoms

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11
Q

Whatisadelusionandhowcanitbedistinguishedfromnormalexperience?

A

Fixed, firmly held belief which is usually false & is held despite evidence & cannot be reasoned away

Out of keeping with patient’s cultural background

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12
Q

Whatisthedifferencebetweensecondpersonandthirdpersonauditory hallucination

A

2nd: voice appears to address them
3rd: voice(s) talking about them

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13
Q

Whichformsofhallucinationsarecharacteristicof
Schizophrenia
Organic disorders

A

Schizophrenia: Auditory, tactile
Organic: visual, olfactory (in frontal lobe pathology)

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14
Q

Whyisanassessmentofinsightimportant?

A

Risk assessment

Presence of illness, need for treatment, usefulness of treatment

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15
Q

What is a ‘word salad’

A

confused or unintelligible mixture of seemingly random words and phrases
a form of speech indicative of advanced schizophrenia.

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16
Q

Inwhatconditionscanhallucinationsoccur?

A

Schizophrenia (auditory, tactile)
Organic disorders e.g. Dementia, head injury, tumour (visual, olfactory frontal lobe)
Psychotic depression (auditory)
Bipolar disorder (auditory)

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17
Q

Whatisthedefinitionofaneuroticdisorder?

what disorders are included under this umbrella term?

A

mental disorder in which the predominant disturbance is a distressing symptom/group of Sx
which one considers unacceptable and alien to one’s personality
without a marked loss of reality testing
behavior does not actively violate gross social norms although it may be quite disabling
the disturbance is relatively enduring or recurrent without treatment and is not limited to a mild transitory reaction to stress
there is no demonstrable organic etiology

Phobias, anxiety disorders, OCD, adjustment disorders, conversion disorders, somatoform disorders

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18
Q

Whyarepatientswithdependentpersonalitiesatriskof

develpingdepression?

A

Vulnerable when dependence on others breaks down

Insecure
Allows others to take responsibility
Usually compliant
Feel unable to self care
Need help to make decisions
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19
Q

Whyisthediagnosisofpersonalitydisorderpotentiallya

dangerousoneto make?

A

Subjectivity in diagnosis
May not be maladaptive (e.g. Narcassistic PD being a successful businessman)
Often present/becomes problematic when failing
Debate whether it exists entirely separately from co-occuring psychiatric disorder(s)
Repercussions for individual

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20
Q

Whatare“simplephobias”?

A

centre around a particular object, animal, situation or activity.

They often develop during childhood or adolescence and may become less severe as you get older.

E.g. Arachnophobia

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21
Q

What are complex phobias

A

tend to be more disabling than simple phobias
tend to develop during adulthood and are often associated with a deep-rooted fear or anxiety about a particular situation or circumstance.

E.g. Social phobia, agoraphobia

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22
Q

Whatproblemsareassociatedwiththelongtermuseof

benzodiazepines?

A

Dependence

withdrawal

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23
Q

WhyareanticholinergicdrugsusedtotreatParkinsonism?

A

Treat extra-pyramidal side effects associated with low Dopamine
Thought to act by blocking central cholinergic receptors, thus balancing cholinergic & dopaminergic activity of basal ganglia

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24
Q

Whatisneurolepticmalignantsyndrome?

A

Rare idiosyncratic response to antipsychotics
Caused by sudden reduction in dopamine activity
Risk renal failure (a med emerg)
Autonomic dysfunction: hyperpyrexia, tachycardia, unstable BP, excessive sweating, salivation, urinary incontinence
Increase in CK
musc rigidity
(Supportive treatment: stop antipsychotic, fluids, monitoring)

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25
What are the side effects of tricyclic antidepressants? 
Cardiotoxic in overdose Anticholinergic side effects (e.g. Dry mouth, blurred vision, constipation, drowsiness, cognitive impairment, hallucinations)
26
Why should chlorpromazine be avoided in the elderly? 
May cause hypotension Increases risk of DVT/PE Affects temperature regulation (increased risk hyper/hypothermia)
27
What are the extrapyramidal effects of antipsychotics? 
Parkinsonism: bradykinesia, mask face, resting tremor, cogwheel rigidity
28
What are the dangers of rapid tranquillisation? 
when medicines are given to a person who is very agitated or displaying aggressive behaviour to help quickly calm them. This is to reduce any risk to themselves or others, and allow them to receive the medical care that they need. Usually using benzodiazepines or antipsychotics Risk loss of consciousness, hypotension, bradycardia, tardative dyskinesia/NMS etc in benzodiazepines
29
What are the symptoms of lithium toxicity? 
tremor, ataxia, dysarthria, nystagmus, renal impairment, and convulsions
30
Who can apply a Section 5(2)?
(Inpatients only) RMO or nominated deputy (doctor on call) Detention for up to 72hrs to allow completion of MHA
31
Who can apply a section 5(4)?
(Inpatients only) RMO Detention of an inpatient for up to 6hrs for medical assessment where mental illness suspected
32
What are the 4 stages to consider in making a Capacity  | Assessment.  
Understand Retain Weigh up Communicate
33
Why is regular supervision important for a psychotherapist?  
Personal well being Well being of patients; protect clients & improve ability to value clients Required by all counsellors & psychotherapists
34
What are the potential advantages of therapeutic community treatment over individual psychotherapy? 
Social relationships and communities provide the context and impetus for a range of psychological developments, from genetic expression to the development of core self-identities. This suggests a need to think about the therapeutic changes and processes that occur within a community context and how communities can enable therapeutic change Evolving emotion-regulation systems
35
What are the symptoms of obsessive­compulsive disorder and how are they treated with CBT? 
OCD: Obsession = unwanted intrusive thoughts which are unpleasant & raise anxiety. Derived from own mind Compulsion: associated behaviour (senseless, repeated rituals but have insight - often a way to reduce distress of obsession) A need for perfectionism, to control, inability to delegate, feelings of doubt & caution, preoccupation with detail CBT: Accept thoughts & divorce of meaning Response prevention (delay response & see what happens)
36
What are the principal differences between psychodynamic  | psychotherapy and  cognitive­ behavioural psychotherapy
``` Psychodynamic psychotherapy (psychoanalytical): the systematic use of a relationship between a patient and a therapist (as opposed to physical and social methods) to produce changes in feelings, cognition and behaviour Attempts to re-structure personality (based on Freud's approach to psychoanalysis) ``` CBT: Focuses on thoughts & assumptions Helps change unhelpful thoughts (cognitions) & actions (behaviours) Theory: ◦we respond to our interpretation of events, not to raw events alone ◦& if this is the case, cognitive change required to produce emotional/behavioural change
37
What is “transference”? 
redirection to a substitute, usually a therapist, of emotions that were originally felt in childhood Past experiences/expectations projected onto real life
38
Why is motivation important in assessing a patient’s suitability for psychodynamic  psychotherapy? 
Require motivation to enquire about inner self
39
Why do patients in psychodynamic psychotherapy often get worse before  They get better? 
Have to address unresolved issues | Conflict
40
What is the difference between delirium and dementia? 
Delerium: organic reaction, fluctuating impaired consciousness, acute onset Dementia: syndrome of progressive & global intellectual deterioration without impairment of consciousness
41
What is the most common form of dementia? 
Alzheimers (60%)
42
What is paraphrenia? 
mental disorder characterized by an organized system of paranoid delusions with or without hallucinations (the positive symptoms of schizophrenia) without deterioration of intellect or personality (its negative symptom).
43
What are the neuropathological features of Alzheimer’s Disease? 
Beta amyloid plaque deposition Neurofibrillary tau tangle formation Neuronal loss: hippocampal, parietal lobe
44
Why is a multidisciplinary approach important in old age psychiatry? 
Multiple symptoms | No cure; manage/minimise symptoms
45
What is an encapsulated delusion? 
a delusion that usually relates to one specific topic or belief but does not pervade a person's life or level of functioning.
46
In what ways may excessive use of alcohol present to the psychiatrist? 
Thymine defociency: Wernicke's encephalopathy (acute) Confusion, ataxia, ophthalmoplegia ``` Korsakoff's syndrome Hypothalmic damage & cerebral atrophy Inability to acquire new memories Confabulation Lack insight Apathy ```
47
What are the health risks (physical and psychosocial) of illicit opioid use? 
Overdose: resp depression Numbness, stupor Addictive: loss of finances, social support, job
48
What is meant by “harm minimisation?” 
acknowledges that some people in societies will use alcohol and other drugs therefore incorporates policies/public health strategies which aim to prevent or reduce drug related harms.
49
What is the recommended safe weekly intake of alcohol (a) for men (b) for  women? 
14 units/week, spread over at least 3 days Units = strength (ABV) x volume (ml) ÷ 1,000 = units
50
What are the symptoms of acute alcohol withdrawal (delirium tremens)? 
Sweats, nausea, tremor
51
Which illicit drugs may produce a schizophrenia­like state? 
``` Alcohol Cannabis Benzodiazepines Barbituates Amphetaines Cocaine Hallucinogens Ffluoroquinolone (permanent) ```
52
What are the diagnostic features of bulimia nervosa? 
Recurrent binge episodes Preoccupation with body weight Inapprop compensatory behaviour to overcome effect of binge
53
What is the cause of amenorrhoea in anorexia nervosa? 
Primary Hypothalmic disturbance = reduced secretion LH & FSH
54
What drugs are used in the treatment of bulimia nervosa? 
Antidepressants
55
What types of psychotherapy are used in the treatment of anorexia nervosa? 
CBT, family therapy, psychodynamically informed behavioural tx
56
Why are tricyclic antidepressants potentially dangerous in anorexia nervosa? 
Both increase QT interval
57
What are the most serious physical complications of anorexia nervosa
Deficiency: Thiamine, K, Na, Ca, phosphate Endocrine disturbance Osteoporosis Sinus bradycardia
58
What are the common causes of acute confusional state?
``` (Delerium) Malnutrition Meds e.g. Benzodiazepines Alcohol (withdrawal) Infection Metabolic abnormalities e.g. Hypoglycaemia Hypoperfusion Hypoxia ```
59
Why are psychiatric disorders difficult to diagnose in people with learning disability? 
Communication barriers | Psychiatric conditions may present in less usual way
60
What is a “behavioural phenotype”? 
patterns of behaviour that present in syndromes caused by chromosomal or genetic abnormalities.
61
What are the features of Down syndrome? 
Physical abnormalities | Intellectual abnormalities
62
What is Fragile X syndrome? 
genetic disorder. Symptoms often include mild to moderate intellectual disability. Physical features may include a long and narrow face, large ears, flexible fingers, and large testicles. About a third of people have features of autism such as problems with social interactions and delayed speech. Hyperactivity is common and seizures occur in about 10%. Males are usually more affected than females. Typically due to expansion of CGG triplet repeat
63
What are the diagnostic features of autism? 
``` Core symptoms: Social difficulties Restrictuve/repetitive patterns of interest/behaviour/activity Present early in dev period Clinically sig impairment Not due to another condition ```

Phase 2: Psyk (1 decks)

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